HomeMy WebLinkAbout20060038.tiff r'OLORADO D 'VlSIIO ! OF 14.1A TER a.:,..,..„ RECEIVE()
roi IVIUrT BE Si1RMITTED ≥� �4�1~�
so DAYS or .:O�,�r-LETIDD ...--
Denver,Sherman Street Room 818
tiroo"aK DESCF_IBED ERE- Denver, Colorado 80203
+YY�OR PRINT IN B'_AC:: i`�2 O °"',�
.M K.
;AMU,CCW!PLETS0N AND PUMP INSTALLATION REPORT
`� K::'?1 B NI.R/?$ R 994)48..:A !yh1F.R RESOURCES
e'~A/ELL OWNER Mc — STATE E^'�:r!EER
1?c.r�a,7.::1 H. Brand c'.ct
3o37 weld at,y,, Rd 19--
ADDRESS —- AR '/� of the SF T o,
�I � �t �� —�--_Y. of Sec. '
:a.Tto ['1,o A'1 T a -4_ , R. 67 1 ~ _
DATE COMPLETED ' ____, p.;
-- 19--- VOLE DIAMETER
�I _in. from_`_a•to__5_34_ ft.
From To Water
Type and Color of Material Lac ��8
0 2.. 07 a;T `_— -— — _ !n. from�5 4 to �ft.
2 53l+eat Weathered shale
I 53 / �$x,e a_ ------in. from_ to_ ft.
hn.ly DRILLING METHOD Rotary
90 i-90 Cihaie ! I CASli'dG RECORD: Plain Casing �_��-��
d1 s C� .aa_�.�y c:? Size'.10 165 , 1i. �e Y Siz 6- & kinc'r3ssee7_,_from _ r r —�_to ��� `t
'i6 170 Eir,. dstoate
170 Shy ::e Size:_�& kind _—._.--___ from 7)45 371 7''r 1. x : :Ie : Grey rock lawyer. i Size— --& kind _
,7'' ; Ot a.:. I — from _�___.to _
374 426 { 41::K.t I
1
26 41?j (Jo al
Perforated Casing
`��''•��Q Size 1.4_11_.-430 451 1/i,>≥ 433 C'.'al ff -— & kind _$ 1-.__ from _
1 —� to L,.2__ft.
43 ,2 <-..
r7) 1r 6 a-.s2i?�e Size __�
x'56 439 (Alai _£3c kind _ _____ fro n _ to s,i Size)9 445 - .":: . ahaie
_`_ & kind �
l 11;. i.S5 r 1 •, .---� from t o_ ft.
I 455 F 469
1�6 473Al GROUTING RECOP,D
I 473 514 Sha?e Mate ----
5t3 5 .$ S^al Material C•`.1men.tu
>� ..1�,� ,male ! 1'' . .___
��r ,nterva�� On
n--534.'/0 ,raMc�. & Sandy c7.e. .
5/0 667 ' ?tufty Clay Placement Method F?a%l�;,ur�on
I 667 + 70 Shale
—
i 6;r'0 __
G / GRAVEL PACK: Size _
16 7 68o shale. —
I1 Interval
! I ITEST DATA
Date Tested
I _,Lt,l �fig
i iI ,Static Water Level Prior to Test-_�0J
1 ---�_ ft.
I
Type of lest Pump , I
I ; .r
�gth of a 1„-r _____4_217._.r..____________
1 TOTAL DEPTH
r"30 Sustained Yield (Meters l
)__2..a_.L'r � --_ Use ltional pages necessary to complete foe, -
111 Final Pumping Water Level ___�j_
i
2006-0038
PUMP INSTALLATION RE FIT
Pump Make }. ��]`
Typer.'
Powered by- tr _ 3, �`�\ ^
HP
1 L �'' A ;
Pump Serial No. ��
6
.J
Motor Serial No. ~ WATER
w�
ici w TABLE
Date I nstal len �; �.w
� ry cc to
Pump Intake Depth +ti V
6-;Remarks _ ij
f•i` (,. �.
4-
, .
i I , •
4.. /
�` I ;.:.•:C.
` t / Y'
'kit/ELL TEST DATA WITH PERMANENT PUMP n. T�lr •'.
WI 0
Date Tested —_—_--- xi
-- — — —_ , ri. !'tj CONE OF
Static Water Level Prior `` °' Dt't;E5.�iIrJd
to Test 0 z",1 ,y
V:. •:,,,,z
Length of Test _— Hours
Sustained yield (Metered)_—.._ GPM 3.¢�.;,' -�
rt e.
Pumping Water Level __� .•.�
Remarks
i;.,
:'-',1;:.
• -
I ' . .
M
CONTRACTORS STATEMENT
The undersigned, being duly sworn upon oath, deposes and says that he is the contractor of the well or
pump installation described hereon; that he has read t e statement made hereon; knows the content
thereof, and that the syyiVis true of his n �Cnoyvled
e.
r/,,,1
Signature `f�`` 1fv C,4. ., , (Ai, •i�7 -/ ` License No./
State of Colorado, County of _ SS
Subscribed and sworn to betore me this day of �, 19
My Commission expires: "�!Y ommission Expires Feb.22,19819
Notary Public .... •-t.�� y, A,_,..___
I FORM TO BE MADE OUT IN QUADRUPLICATE. WHITE FORM must be an original copy on both sides and signed.
WHITE AND GREEN copies must be filed with the State Engineer.PINK COPY is for the Owner and YELLOW COPY is for the Driller.
ws:_S.a.,v. /6 COLORADO t
DIVIS.ON OF WATER RR: 7;P:,•_F4Iti%'%p
• 81�.ntennial Bldg., '1313 Sherman St., Denver, Co. ddo 80203 C,-;?„v
•Apr)Iicatio9 must P Rit I �`,PPS_(CATiON FORM i'° i� �1�'18
be complete where — Mu;6
..ppltcable. Type or IK) A PERMIT TO USE GROUND `.'ATFR4r TER RESouRCES .,;'�.tO �.
print in ;i_�CK ( <) A PERMIT TO CONSTR:'CTA WELL ..• "18I?1E •:' /f-�
^ -— FOR: TO . �_�.,_.._.. ...
INK.Noovr.rstrikes ('�C! A PERMIT li`J;;i"r�t_i.;� PUMP
r
or erasures unless (�'� REPLACEMENT FOR NO. _ / -• �?�
initialed.
'Nei 7 t a
I )OTHER cJ
WATER COURT CASE NO.______________ %
(-1) AP'LIC?�.N"i mailing tlress -- FOR Jl�
FOR OFFICE USE ONLY: DO NOT WRITE THIS CO 3:.c
NAME_- ,Lc^iJc 3 rI IP ., f /,� /
�.h r� f_ s ;�j 'r 'ti� tl l tv ...
Receipt Na. o r!
( Basin
CITY F�f`� �
^ n �n!_ ('� I �_ Dist. _,—� —
I (State) vz io i
CefmornoNS OF APPROVAL
_T - _ .._.__. ‘'.1F'I:- :--a 5 This well shall be used in such a r_ ____._._ ,.._ � way as t cause
( )�L{ ^,t!LOCATION Or• PROPOSED __ _.•- —j no material injury to existing water rights. 'The
ROP3SED WELL iss
uance the permit der.; not assure the applicant
S i that no injury vvill occur to another vested wa':..r
r'uunty` 4? � right or preclude another owne,• .::f a vested w::_er
), I ----------
/ .-- right from seeKif)g relief in a civil court action.
.elf-- �_�a of tl'ie_, —,_ Tj Section '~ i
— __.—_ ..,I. _
-- Rng•_.-1✓�..L.�. i.=' � 1;',4';".Z av:x. .'I !',.., , K -.L'�.:67! / �'s7,/,e/i7
:N.S!/ �--' •- tSI.•1,.�.�rd'i<� �,aY.•.F��a t.:l'.� P. 4•'•�f r.k'°`��^ 4,S`. c. ntr.._-•
_ ........+» <iv'r•''�-l( •a y.,I ti Win: n..,,.� E i e r'14`x'6{'C 1:.i
) WATER E f' USE
C /t `1 n t� t—.--_r•�..._.,....�._.:...-.__..w..._..� -•�, ,,y. �,� ,..[�eC; nl�,�1 f �_r � ,�g X� AND
3 I USL ,-llV7J•Y'Y 7..! DATA ., .� .s^p , .y � Ifs- i'?wM1iY:...� AM i;J Y1�E`S[:�S.�noG.7 ��.r{,.�.r..� .-IY C�.j
: i i"PLIN •C(Z WATER FELL A NLI - P f 1671 P Az iC1'•�
�'SI'.J
.,O•. .eC i'C n THE ENCLOSED S k•7 4'M'1
^Proposed maximum pumping rate (gem} (....2__________ l s;iitrf S��' "h° �'a) , � ~_
�. i ,.oJ. ► y D) in iw;ESQ �E
g2:' �`t R. JJ.,
. vera annu;;lamountof n ry• •:J 6:' .� C'_;'.,` ama, It t'� ik'r°�T-.ILL�A'ii
g_ ground water rk'd w•i +�^•mss,. �,� ,
to be approp,• •.ecl (acre-feet): �.'`'"' Q °� I(. "k !,7?-43] • , rah•. a
Number of acres to be irrigated: /
Proposed total depth (feet): __ -7 0 0
Aquifer ground water is to be obtained from: `
Owner's well designation _
r B0 L)ND ATr_R T O BE USED FOR: --
( ) HOUSEHOLD USE ONLY • no irrigation (0)
(%S) DOMESTIC (1) 1 ) INDUSTRIAL (5)
( 1 LIVESTOCK (2) ( ) IRRIGATION (6)
( f COMMERCIAL (4) 1 1 MUNICIPAL (8) ;
( I OTHER (9)_
DETAIL THE USE ON BACK IN (17)' -_ APPLICATION APPROVED
(4) DRN.LER — — --`_- PERMIT NUMBER _ •ff,n.� --DATE ISSUED Name1 '��._ •�i r..t_ •
- '�'f�—__�..
C r r{�t., c,` — -- XPl RATION HATE 't"�
Street ', >� r� i.)r . ,_ —�_' I ---��
.! ers . Hof ga .A44 4'
(state) (zip) :7' (S'rriT�EN G)rdcEFiT --
Telephone�No. (� gY
'_______` LY2i —. COUNTY
rr`�
(5) THE LOCATION OF THE PROPOSED WELL and the area on (6) THE WELL MUST BE LOCATED BELOW
which the water will be used must be indicated on the diagram below. by distances from section lines.
Use the CENTER SECTION (1 section, 640 acres) for the well location.
/ C-6. ft. from S0 k• h sec.line
4_1._ — 4...4... — -- — -t — —ti— — I -- ..4_ —
- 4- �((north or soul '
Rai — 1 MILE,5280 FEET---+1 j 2hQ i:_) ft. from P....4-._.c, sec. ^
(east or west)
f + L + ± rt " + LOT BLOCK FILING #
I i I 1 ,
— NORTH SECTION LINE -_ SUBDIVISION Al�� � 1`t��-f� ��vC�
�� r1
{ {7) TRACT ON WHICH WELL WILLI
3
LNORTH w_ _ I - l LOCATED Owner:-IL
wner: )'r)J1 , Arc
A1-1
? ' D No. of acres --e__ *__,4.____:)____. . Will this be
I -i
a o I I ' m `-the only well on this tract?j/' -
-t- -#- -t- Pl... { I r - I- ---
y ! Z
(8) PROPOSED CASING PROGRAM
I y I Plain Casing
+- t— --1— I ? •+ I S r
li, r'//�/j�l in.from 4 i ft. to P —ft.
I i '7`r"•_ in.from /5 -ft. tom_°6_ft.
T -- i _— -I-- -. Perforated casing
SOUTH SECTION LINE
I I — 1/ �� in. from ,gib v ft. to ../6 e) ft.
' 4- in. from ft. to `t.
I ( . (9) FOR REPLACEMENT WELLS givedistance
and direction from old well and plans for plugging
f -- + - + - + - T •-- 4_ — --F -
- -- j- it: //
The scale of the diagram is 2 inches.! 1 mile 0 _'1�. ,-.s. It' p -�
Each small square represents 40 acres. n ILt
L,? Q ! °f )tO hP pIk..,1Pd
• • WATER EQUIVALENTS TABLE-(Rounded Figures) 1
An acre-foot covers 1 acre of land 1 foot deep C. c/o. •f-- '`
1 cubic foot per second(cfs) ...449 gallons per minute(gpm)
A family of 5 will require approximately 1 acre-foot of water per year.
1 acre-foot...43,560 cubic feet. . .325,900 gallons.
-
1,000 gpm pumped continuously for one day produces 4.42 acre-feet.
(10) LAND ON WHICH GROUND WATER WILL BE USED:
Owner(s): At 1...b a n.+ca N. r'+S - 8 r& n A No. of acres: 40
Lega(description'it4 (d-. Co , Ug 1p4 SE f/4 T W P /AJ P, i(a f^ 7(4 Sec i5--- 41In
(11) DETAILED DESCRIPTION of the use of ground water: Household use and domestic wells must indicate type of disposal
system to be used. jf ii ( ` f
y H e a s t h o l'tl JL Lk t43 A-I ti— �(/�!t r•c r r j
15 t� 641 , s L'n 7`1 c, -h. ,.,!('� et.,_,.1.. i.to k c l-. 1- i e (a- C E i( i `s d;)
(12) OTHER WATER RIGHTS used on this land, including wells. Give Registration and Water Court Case Numbers.
Type or right Used for(purpose) Description of land on which used
(13) THE APPLICANT(S) STATE(S) THAT THE INFORMATION SET FORTH HER rON IS
TRUE 0 THE BEST OF HIS KNOWLEDGE.
: R.V\A-.1".14V
SIGNATURE OF APPLICANT(S)
Use additional sheets of paper if more space is required.
•
CO LC"*"'' DO ))L1SEON OF WATER RE. )U CESTYPF
PRINT tL AC, INK 818 Centennial Bldg., 1313 Sherman St. MAY .': X78
COPY OF ACCEPTED Denver, Colorado 80203 YJATER RESOWItft
STATEMENT NAILED
ON rEouEST. STATE OF COLORADO ;? EfRk"I;s4
---1---., AFFID DAVIT .1.r.:1:'..
COUNTY OF ,_ I SS. _ _
STATEMENT OF BENEFICIAL USE OF GROUND WATER
AMENDMENT OF EXISTING RECORD
X LATE REGISTRATION
PERMIT NUMBER LOCATION OF WELL
THE A;`F IANT(S) /r��L C .r -r iJ _iL_P ,•,cv�\0 -- c'allnty t� e. /I
whose mu,ling '-'
address is J . _f f _dA fi NC �y"- �} f t
^� (_—� t JK—�_ /. of v,e _ -".> . ''A, Section ./ J •
City .-- s:-'� -- .V�1f.• f,EN4__ y (l I-_.. . — ...—�C` i2_•r+! —_ Tells. _ ! �,i_i . Rng• _—k7it) 6 P M
( l n
T•` (S'�rE) It!1+) co,-; Si 15 OR Y+!
being duly sworn upon oath, deposes and soys that he (they) is (are) the owner(s) of the well described hereon; the well is
/t-1---- c- G/located as described above, at distances of 1_. +.� feet from the ;..b•.4t:-o t, section line and /0(;
--- -- feet horn the
IRON IM OP 5011,4)
-41.3 1._ section lino; water from this well was first applied to a beneficial use for the purpose(s) described herein on the
day of __.._�`�-�-M' , 19 1 41_ ; the maximum sustained pumping rate of the well is °—gallons per minute, the pumping
rate claimed hereby is . t.::17__ gallons per minute; the totol depth of the well is 6C‘1 O. feet; the average annual amount
of water to be diverted is / acre-feet; for which claim is hereby made for _ `"^-' `jc G
purpose(s); the legal description of the land on which the water from this well is used is
4-
of which
(..___acres ore irrigated and which is illustrated on the map on the reverse side of this form; that this well was completed in
compliance with the permit approved therefor; this statement of beneficial use of ground water is filed in compliance with low; he
(they) has (have) read the statements made hereon; knows the content ftereof; and that the same are true of his (their) knowledge.
(Ci,MF'Lr'�'EAR IVfV!r Sint' OF THIS FORM),....27/ /0 a ? ry
•
Subscribed and sworn fL FOR OFFICE USE ONLY
to before me on this ' day of 27-)+— j — 19 7 j' 4
Uhf Court Cost No. _
li
My Commission expires: 4- i g 7 r',
IBt.LI 1
/r--- fl,,,, ? Prior. ___ _ Mo. --- Day -
\-- .. Cf y .� . Yr
r
OI RR PUBLIC Div,
Cty. _
'
ACCEPTED FOR FILING BY THE STATE ENGINEER OF COLORADO P.PURSUANT TO THE FOLLOWING CONDITIONS: Sec._ __ yr, 'A
i
Ii
b Well Use
II
Dist. ._ Basin _`-- Mon. 12),s
;I
g:4° .
1 _1 6 '0/9 jpilgee .< 6. o �! 7,21o? ;ssa,'3
DATE > p ,STATE ENGINEER BY --
•
Well drilled by 6.t.f �1 tV C9 (-2) k)
Permanent
Pump installed by L___A- e7 r,-,LO e 0 •
Lic. No.
Meter Serial No. _^ ❑ Flow Meter Date Installed
Owner of land on which
water is being used At L J) 9 mi. /1 4 , (3 r f1- n
THE LOCATION OF THE WELL MUST BE SHOWN AND FOR LARGE CAPACITY IRRIGATION WELLS THE
AREA ON WHICH THE WATER IS USED MUST BE SHADED OR CROSS-HATCHED ON THE DIAGRAM BELOW.
This diagiam represents nine (9) sections. Use the CENTER SQUARE
(one section) to indicate the location of the well, if possible.
I --- I I 1 I
l
- + - + -- + - + - i - + -
H H E "--I -7-----
- + + --I- -F + -- + —
NORTH SECTION LINE
NORTH f -4 A
-- + </' -- - - M LU
m "� �1
-F rn — - --- l-
jvii +
SOUTH SEC ION LINE ��
+ + -I_ - + - +- --'
I t
THE SCALE OF TIE DIAGRAM IS TWO INCHES EQUALS ONE-MILE
-- -f- - + -�- -t-- -t- -- + -- + -
� I
WATER EQUIVALENTS TABLE (Rounded Figur s)
An acre-foot covers 1 acre of land 1 foot deep.
1 cubic foot per second (cfs) . . . 449 gollons per minute (gpm).
1 acre-foot . . . 43,560 cubic feet . . . 325,900 gallons.
1,000 gpm pumped continuously for one day produces 4.42 acre-feet.
100 gpm pumped continuously for one year produces 160 acre-feet.
(WHITE AND PINK COPY TO BE FILED WITH THE STATE ENGINEER
PINK COPY WILL BE RETURNED TO OWNER)
CC;l-C)II -a!)r) DIVISION OF WATER l 'OURCES
. /"V: r.y111. „ti rl I'i ,1 1c 73 'retitle ;r. Ucnve r -
p lut u f ^-r:
ITFIM1T APPLICATION FORM
111 I1° OC,I a I1 H:HiI ill 11 ( 0RUt1tn ''.VAltF) "� . `'t`'r i' Ad., IT II, I
�;1 i" It R^all in f7NSl'R 11CTAWELL "z r a( � fr
nit i r1 NCIC tC i 1 '<.) ‘'. flRhll I li )'TALL- A [ lJi1p a
s 1r
d ,
rI, in - llt;l';q 4
Itni !i,
(NitGf L ^.(:GPAFNT FOR PJ O. ��t �� (3 t tAr
l nil(FR - —
APP 1 !CANT milling address
FOR OFFICE USE ONLY. 90 NOT WRITE IN TENS COLUMN
1l ,
•_ ,-- r`_ Fj .. 1J • 1 Rereip1 No
(
----. Emil Dig[.
1 — _
f A r t I. roirH CONDITIONS OF APPROVAL_
-Hi FP II LI0 (^ r• .t.,j )) This well shah he used in such a way as to cause
--- --- -- no material injury to existing water rights. The
I ; I ocis,Tjori (. P oPOS I� t,dELL
kisiThilCe or the permit does not assure the applicant
that no injury will Occur to another vested water
right or preclude another owner of a vested water
r ' / 5
right from seeking relief in a civil court action.
I • 1
l 1 r13 / L ( P rl (6.-- ,i) /22�
) L
n r_ /_ DATA v
1 mil I „� �lY
/ lv
❑ It ril rl rat hoot) .� l ` it ,R —
{ u cur [ t tI ()nod . II._r �.
'Vi J d..
1
i
7:�,
,CS NJ 1 riynted:tom; 7___ _7)P:..” TTrl depth (Inert-_—. - (` It
>r1 Her u r and y,,rater is to be 0b) lererl from:
---7:—/ y-
JF V ,� ..
GROUND TO BE USED FOR.: / j7-12
t IIOtif F)r0LD USE ONLY - nonotation 10) 6' 7 / �'�
t)SI DOMESEtc l! 1 I INDUSTRIAL 5)
I i IVE T0CI< (hi 1 I IItRIGA-NfN (5)
I L _G:SE 1U:rid_ Ll' i ) M.1LINICIPAI_ (9)
(UllEIR to - _
APPLICATION APPROVED
DS.[-UT T, ,E USE rtNn-nrl< mill) --
(4) DRILLER, PERMIT NUMBER
1, 1p DATE ISSUED
EXPIRATION BATE
Str
I r PI r
,l t� :? ( . - t , / 4' r 4O - ___
r t _-_ r-i7,) -- (MATE ENGINEER)
Tt I. I;ho ie No lt- '.L= ( L =} U AY..
Y -.—_
� _- Lie i.b, - -
- -
10. COUNTY
2(yx,
Ne- c . ‘ EX
Jk/ try_ , i
gins
(17(-(__) O1,03v,
ggyYE.'Hw'�4`St
Qco
•7,5 -z s-/
tb
7 --
.
•
Weld County Health Department
ISIS HOSPITAL ROAD
GREELEY, COLORADO 80631
1303) 353-0540
r
Date ///-1/41— 19/e
Received of anairr
Addr re .fie —,t/ V (P.
i�/7n J
AMOUNT?
C64 _ & �Ilars
ao
PAID ONOld
IN FULL ACC_0UNi Balance
Am t Less
s
New
Balance
CASH 35 At; 66K; DRAF �MONBY"
For °� /fil/�i�
Recd
3 7 5 31 ) /
'�
WELD COUNTY HEALTH DEPARTMENT
1516 Hospital Road Permit No. ..?„,)_zerz
Greeley, Colorado
PH. 353-0540
..application for permit� to install, construct, an Indivi ua]. Sewage Disposal System.
nmer �rrr, /1A/la�� 4 E3eicCC -SAS/ad-et -
D'rections to site. Hwy Address� �� Phone (o �jr-X/47
_�_Rd. gj Nmi, E mi, Sarni, W_mi
Lega Description: Pt -
Sec. ,T N, RW, Sub.
Lot Blk
General Information
De t. Use Onl
No. Bedrooms
No. Baths No• Persons Pete rate (avg. of 3)
Basement Plumbing Soil Type
Size of Lot dlAen ,
H2O supply (if-well give depth) 0 • d H2O Table Depth
New Home t----Mobile Home Modular Add'n Lot Grade
Engineer Design Yes No Type of sewage dPosal requested:
Septic tank �Pri If YES-reason:
�y Other Comments:
This is to certify that the system is NOT within 400 ft. of a public sewer 7(
Installation instructions: (Minimum Requirements)
Septic Tank Gals. Absorption Trenches -5-7(j OtherOr
Sq. Ft.
Special Instructions�" Seepage Be Bed
Sq. Ft.
This system will be constructed and installed in accordance with the above specifications
and regulations regarding individual sewage disposal systems in Weld County, Colorado.
This permit shall expire at the same time as the building permit, or, if no building permit
is issued, the permit shall expire 120 days after its issuance if construction has not
been commenced. f
Date: /1— /1— gd Owner: )( fps � ✓fG,4/1
Applicant:
The plans and specifications as shown are approved pending payment of permit fee.
Date:Saan:
The above system insp c d and f un o comply with nplan iand description.
Systems Contractor: d(A/ Date:
Sanitarian:
Engineer Review:
(Date) (Signature)
Permit Fee: $ �71' C
Received by. -
_ Date: // y7. go_. ----
19-79-122
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